Effect of Prehabilitation Interventions in People Affected by Bladder Cancer on Long-Term Physical, Clinical, and Patient-Reported Outcome Measures: A Systematic Review

PURPOSE: To understand the effect of prehabilitation interventions on ≥30 days post-treatment outcomes including physical functioning, clinical, and patient-reported outcomes in people affected by bladder cancer. 

METHODS: This systematic review included all randomized, quasi-randomized, or single-arm studies in patients affected by bladder cancer (irrespective of stage or treatment modality) that compared prehabilitation intervention(s) with standard care. A range of key terms related to bladder cancer and prehabilitation were developed to search the four electronic databases. Articles were assessed according to predetermined inclusion and exclusion criteria. A methodological quality assessment was performed. 

RESULTS: Of the 932 studies identified, 14 studies were included and represented 1,034 participants. The interventions included multimodality prehabilitation (n 5 5), exercise-only programs (n 5 3), nutrition-focused interventions (n 5 2), educational support (n 5 3), and smoking/alcohol cessation counseling (n 5 1). All of the studies were conducted in patients treated by surgery, therefore clinical and research gaps exist in the prehabilitation interventions among patients treated by intravesical therapy (ie, BCG) or radiotherapy. The key findings highlighted that multimodal program mainly showed improvements in physical function outcomes. Exercise-only interventions demonstrated some benefits in physical function. Nutrition-only interventions did not show any statistically significant improvements. Education programs showed improvements in patient-reported outcomes. Smoking and alcohol cessation counseling achieved notable abstinence rates, which were associated with fewer postoperative complications. 

CONCLUSION: This review suggests that prehabilitation interventions may benefit patients with bladder cancer, particularly exercise and education programs, which showed improvements in physical function and patient-reported outcomes. However, the evidence remains inconclusive, with no clear impact on clinical outcomes such as complications or hospital stay. More robust studies are needed to determine the most effective prehabilitation strategies for patients with bladder cancer.